title: Continuing need for and provision of a service for non-standard implant removal.
abstract: METHODS
  Information is presented on the management of women referred to a sexual health service during a 1-year period for management of a non-palpable contraceptive implant or of a palpable implant considered unsuitable for routine removal.
  
  
  RESULTS
  Fifty-two women were referred. Thirty-four implants were non-palpable and their depth on ultrasound ranged from 2.7 to 12mm. Seventeen were fully or partly palpable and their depth ranged from 3mm or less (16 cases) to 5.6&emsp14;mm (one case). Nine had had previous failed attempts at removal, including three with two previous failed attempts. Three implants were located at sites other than the medial aspect of the arm, and were associated with long localisation times. Forty-seven implants were removed at a one-stop clinic appointment through a 2-3mm incision using ring forceps. The mean time for removal from making the incision to complete extraction was 4.8&emsp14;minutes. Three cases judged to be of higher risk were removed under local anaesthesia in theatre through a 15mm incision. These included the only case where removal was attempted unsuccessfully in the outpatient clinic. Seven of the implants were Nexplanon(®), including four cases seen during the last month of data collection.
  
  
  CONCLUSIONS
  Removal with the technique described is rapid, with an average time of 4-5 minutes, and less than 10minutes in >90% of cases. Preliminary indications suggest that the introduction of Nexplanon has not resolved the problem of deep implant insertion. Based on our experience we suggest criteria for centres providing removal of deep implants.
authors.affiliation: Consultant in Community Gynaecology and Obstetrics, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Pillai
authors.forename: A Caroline
authors.initials: AC
authors.lastname: Gazet
authors.forename: Megan
authors.initials: M
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm; D002983:Clinical Competence; D003271:Contraceptive Agents, Female; D017135:Desogestrel; D020878:Device Removal / Q000379:methods*; D004343:Drug Implants; D005260:Female; D006801:Humans; D018084:Ultrasonography, Interventional; D016387:Women's Health; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel
keywords: Family Planning Service Provision; Implants